The GaBP Ring™ device is an annular restrictive ring placed around the surgically created pouch during a gastric bypass procedure to provide a stabilized pouch outlet.
The GaBP Ring™ Autolock System includes the GaBP Ring™ device and the Gastrostomy Site Marker. The GaBP Ring™ device is an annular restrictive band intended to be placed during a gastric bypass procedure to limit the post-operation dilation of the gastric reservoir for improved maintenance of weight loss. The optional Gastrostomy Site Marker is intended to be placed onto the bypassed stomach to identify the location for possible future percutaneous placement of a gastrostomy tube.
The GaBP Ring™ Autolock is designed for use in bariatric surgery, with the creation of a restrictive pouch.
The GaBP Ring™ device may not be used on:
The Surgeon must verify the compatibility of the GaBP Ring™ device with any other instruments to be used together in the surgical technique, prior to attempting band placement. Smooth jawed clamps should be used to handle the rubber areas of the GaBP Ring™ device.
Mechanical failure of the GaBP Ring™ device due to cutting, puncturing, or overstressing and subsequent separation at the damaged area may result in complications.
Periodic radiographic observations are recommended. If there is band erosion, the GaBP Ring™ device can be removed endoscopically.
The GaBP Ring™ Introducers should be removed from the patient, and documented.
Outlet stenosis can occur from an improperly sized GaBP Ring™ device.
It is the responsibility of the Surgeon to advise the patient of all potential risks and complications of the various procedures and devices.
The GaBP Ring™ device has a soft consistency that provides patients with comfort and safety. The device is radiopaque and made from implant grade silicone rubber. The ends have a plastic one-way locking mechanism that can be applied manually or laparoscopically. The device is reinforced with a monofilament core for strength and to help control food intake. The device is supplied with two silicone rubber tips, GaBP Ring™ Introducers, used to help feed the device into position around the physician created "pouch". The GaBP Ring™ Autolock System also includes a circular flat radiopaque silicone disk called a Gastrostomy Site Marker that is placed on the bypassed stomach as a locator mark for future gastrostomy tube placement.
What is the function of the GaBP RingTM device in the gastric bypass operation?
The GaBP Ringdevice provides a stabilized pouch outlet and prevents the formation of a large gastric reservoir, consisting of the pouch, outlet and proximal small bowel; thereby, maintaining the restrictive function of the gastric bypass operation.
Why should I use the GaBP RingTM device?
The Roux-en-Y gastric bypass is the gold standard bariatric operation; however, up to 40% of patients, especially patients with a BMI > 50, will fail to achieve or maintain successful weight loss in the long-term. Use of the GaBP RingTM device to help patients maintain the restrictive function of the gastric bypass, allows more patients to achieve and maintain their weight loss for a long time.
Do all gastric bypass operations need to be banded?
Yes. Although not all gastric bypass patients will experience reservoir dilation that defeats the restrictive function of the operation, pre-operative factors for determining which patients are more likely to have a failed gastric bypass are unknown. As the benefit of banding all gastric bypass operations to salvage the 20-40% of patients who would otherwise fail outweighs the risk of use, we recommend a proactive approach of banding all gastric bypasses and restrictive gastroplasty in the primary operations.
What are the benefits of using the GaBP RingTM device to band the gastric bypass?
The benefit of using the GaBP RingTM device as a proactive treatment of possible gastric bypass failures reduces the risks from complications associated with pouch and outlet dilation, like weight regain, that require re-operative intervention. In addition to the weight loss benefits, use of the GaBP RingTM device helps to decrease the incidences of gastric outlet stenosis, dumping or reactive hypoglycemia, and GERD post gastric bypass.
What are the risks of banding the gastric bypass?
The primary risks associated with use of the GaBP RingTM device include ring erosion (<2%) and food intolerance (< 5%). The incidence of erosion or food intolerance can be minimized by utilizing a properly sized ring, proper surgical technique during implantation and avoidance of infection. Food intolerance is a desirable effect of the restrictive function, which provides for the weight loss and weight loss maintenance; however, some patients may require ring removal for severe food intolerance. Ring erosion and food intolerance should be treated expectantly or by endoscopic dilation/removal of the ring. Surgical removal should be the last option if endoscopic dilation/removal is unsuccessful.
Why is the banded gastric bypass not as commonly performed for weight loss?
The open Roux-en-Y banded gastric bypass was introduced by Dr. Fobi over 25 years ago and became widely practiced with the use of surgeon-fashioned rings. However, until recently there were no devices manufactured specifically to band the gastric bypass, and the advent of laparoscopic surgery made it more difficult for surgeons to fashion rings inside the peritoneal cavity.
How long should the gastric pouch be in the banded gastric bypass?
The vertical pouch should be created5-7cm long, with a size 36–40fboogie in the pouch.
Where is the GaBP RingTM device placed in the banded gastric bypass?
The Ring is placed at approximately 4 cm below the GE junction and2cm above the GJ anastomosis.
What size GaBP RingTM should be used?
TheGaBP RingTM device should be loose around the pouch at the time of implantation. Generally, we recommend the 6.5 cm size for female patients, the 7.0 cm size for male patients, and the 7.5 cm size for the super-obese or revision cases.
Variations in outcome are not significant between the various sizes; however, there has been better tolerance of solid food and variety of food intake with the longer circumferential lengths.
How should the gastrojejunostomybe performed?
The gastrojejunostomy can be done with hand sewn, with a linear stapler or an Orville stapler.
How do I prevent band slippage?
Place a 3-0 absorbable suture at the anti-mesenteric boarder to anchor the GaBP RingTM device to the pouch. DO NOT cover the Ring with the gastric wall, as this may increase the likelihood of erosion.
How much does the GaBP Ring™ cost?
The cost of the GaBP Ring™ device is a small addition to the total cost of a traditional gastric bypass operation, but the long-term benefits are huge. When considering the cost of adding the GaBP Ring™ device, it helps to consider the potential expense of a revision or the likely decrease in quality of life for patients who are unable to maintain a stabilized pouch outlet in the years following surgery. When all of the benefits are considered, it’s easy to see the value in the GaBP Ring™ device. For detailed pricing, please contact your local distributor.
Are there more risks associated with using the GaBP Ring™?
The medical literature comparing the two procedures shows no significant difference in complication rates.